Here is the form I use.
To. ____ Serial no. ____ Date issued ____
From____ Ref____
Classification: Quality/Environmental/Safety&Health
1. PROBLEM DESCRIPTION
2. USE THE TEAM APPROACH
Champion ________ Team members _______
3. CONTAINMENT AND SHORT TERM CORRECTIVE ACTIONS.
4. DEFINE AND VERIFY ROOT CAUSE
5. IMPLEMENT PERMANENT CORRECTIVE ACTIONS
6. PREVENT RECURRENCE
The
FMEA was revised to add ___ as a concern with the following RPN value: Severity__ Occurence__ Detection__ RPN__
Approved by
7. VERIFY PERMANENT CORRECTIVE ACTIONS
8. CONGRATULATE THE TEAM